A 35 year old man presents with features suggesting severe sepsisHis WCC and neutrophil count suggest severe sepsis on background of ITP with severe thrombocytopaenia.

You must find out whether he has had a splenectomy. If so, has he been immunised?

What is the source of his sepsis?     …..in this case a pneumonia

His treatment should focus on management of his sepsis

ITP treatment in this case should be discussed with haematology as steroids/ platelets may not be indicated in this case.

See here for latest on post splenectomy recommendations

and here for an interesting article: http://www.racgp.org.au/download/documents/AFP/2010/June/201006jones.pdf